title: Clinical profile and underdiagnosis of pulmonary hypertension in US veteran patients.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a key contributor to cardiovascular morbidity and early mortality; however, reports are lacking on the epidemiology of PH in at-risk patient populations.
  
  
  RESULTS
  The echocardiography registries from 2 major Veterans Affairs hospitals were accessed to identify patients with at least moderate PH, defined here as a pulmonary artery systolic pressure ≥60 mm Hg detected echocardiographically. From a total of 10 471 individual patient transthoracic echocardiograms, we identified moderate or severe PH in 340 patients (332 men; mean, 77 years; mean pulmonary artery systolic pressure, 69.4±10.5 mm Hg), of which PH was listed as a diagnosis in the medical record for only 59 (17.3%). At a mean of 832 days (0-4817 days) following echocardiography diagnosing PH, 150 (44.1%) patients were deceased. PH was present without substantial left heart remodeling: the mean left ventricular ejection fraction was 0.50±0.16, left ventricular end-diastolic dimension was 5.0±0.9 cm, and left atrial dimension was 4.4±0.7 cm. Cardiac catheterization (n=122, 36%) demonstrated a mean pulmonary artery pressure of 40.5±11.4 mm Hg, pulmonary capillary wedge pressure of 22.6±8.9 mm Hg, and pulmonary vascular resistance of 4.6±2.9 Wood units. Diagnostic strategies for PH were variable and often incomplete; for example, only 16% of appropriate patients were assessed with a nuclear ventilation/perfusion scan for thromboembolic causes of PH.
  
  
  CONCLUSIONS
  in an at-risk patient population, PH is underdiagnosed and associated with substantial mortality. Enhanced awareness is necessary among practitioners regarding contemporary PH diagnostic strategies.
authors.affiliation: Department of Cardiology, Veterans Affairs Boston Healthcare System, Parkway, Boston, MA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Maron
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.forename: Umar A
authors.initials: UA
authors.lastname: Khan
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Jankowich
authors.forename: Hope
authors.initials: H
authors.lastname: McChesney
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ferrazzani
authors.forename: Sainath
authors.initials: S
authors.lastname: Gaddam
authors.forename: Satish
authors.initials: S
authors.lastname: Sharma
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Rocco
authors.forename: Jayashri R
authors.initials: JR
authors.lastname: Aragam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D016279:Atrial Function, Left; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization; D002983:Clinical Competence; D004452:Echocardiography; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006787:Hospitals, Veterans; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014655:Vascular Resistance; D016277:Ventricular Function, Left; D014728:Veterans / Q000706:statistics & numerical data
keywords: diagnosis; epidemiology; pulmonary hypertension